ORTHOPAEDIC CENTER OF SOUTHERN ILLINOIS, LTD. – Orthopaedic Surgery Physician, NPI 1932432143
Orthopaedic Surgery Physician
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Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for ORTHOPAEDIC CENTER OF SOUTHERN ILLINOIS, LTD.
839 M L KING DRIVE
CENTRALIA, IL 628013001
Phone: (618) 545-0894
Fax: (618) 545-0914
Type: Location
Orthopaedic Center of Southern Illinois, 4121, Veterans Memorial Drive, Mount Vernon, Jefferson County, Illinois, 62864, United States
MOUNT VERNON, IL 628646262
Phone: (618) 242-3778
Fax: (618) 242-2551
Type: Mailing
M L King Drive, Centralia, Marion County, Illinois, 62801, United States
CENTRALIA, IL 628013001
Phone: (618) 545-0894
Fax: (618) 545-0914
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2016-03-24
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Past revalidation due date
Earliest CMS due date was 2025-08-31 (280 days ago).
Enrollment records
2
Earliest due date
2025-08-31
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| O20040105000416 | O | Clinic/Group Practice | IL | TBD |
| O20160324000731 | O | Physician - Orthopedic/Orthopedic Surgery | IL | 2025-08-31 |
What to do next
- Verify current status on the CMS Revalidation Lookup Tool immediately.
- Complete revalidation in PECOS or contact your Medicare Administrative Contractor (MAC).
- Overdue revalidation can lead to deactivation of Medicare billing privileges.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 62801)
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